Liu J, Wang Y, Wang RH. Incidence and risk factors of post-traumatic stress disorder in patients after endoscopic submucosal dissection for early gastric cancer. World J Psychiatry 2026; 16(5): 116272 [DOI: 10.5498/wjp.v16.i5.116272]
Corresponding Author of This Article
Rong-Hua Wang, Office of Academic Affairs, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China. ronghua6662025@163.com
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Psychology, Clinical
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Retrospective Cohort Study
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May 19, 2026 (publication date) through May 5, 2026
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World Journal of Psychiatry
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2220-3206
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Liu J, Wang Y, Wang RH. Incidence and risk factors of post-traumatic stress disorder in patients after endoscopic submucosal dissection for early gastric cancer. World J Psychiatry 2026; 16(5): 116272 [DOI: 10.5498/wjp.v16.i5.116272]
World J Psychiatry. May 19, 2026; 16(5): 116272 Published online May 19, 2026. doi: 10.5498/wjp.v16.i5.116272
Incidence and risk factors of post-traumatic stress disorder in patients after endoscopic submucosal dissection for early gastric cancer
Jin Liu, Yong Wang, Rong-Hua Wang
Jin Liu, Department of Endoscopy Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Yong Wang, Medical Device Registration Review Section, Chongqing Center for Drug Evaluation and Inspection, Chongqing 401120, China
Rong-Hua Wang, Office of Academic Affairs, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Author contributions: Liu J and Wang RH conceived and designed the study; Liu J collected and analyzed the data and wrote the initial draft; Wang Y contributed to data analysis and methodology; Wang RH supervised the study and critically revised the manuscript. All authors approved the final version for submission.
Institutional review board statement: This study was reviewed and approved by the Medical Research Ethics Review Committee of The First Affiliated Hospital of Chongqing Medical University (No. 2024-589-01).
Informed consent statement: Informed consent was waived by the Medical Research Ethics Review Committee of The First Affiliated Hospital of Chongqing Medical University because this was a retrospective observational study using de-identified clinical data with no direct patient contact.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.
Corresponding author: Rong-Hua Wang, Office of Academic Affairs, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China. ronghua6662025@163.com
Received: November 18, 2025 Revised: January 1, 2026 Accepted: February 6, 2026 Published online: May 19, 2026 Processing time: 162 Days and 23 Hours
Abstract
BACKGROUND
Endoscopic submucosal dissection (ESD) has become the preferred treatment for early gastric cancer due to its minimal invasiveness and organ preservation. However, the cancer diagnosis and treatment process may serve as a traumatic source triggering post-traumatic stress disorder (PTSD) in patients. The incidence and risk factors of PTSD in early gastric cancer patients following ESD remain poorly characterized.
AIM
To investigate the incidence and risk factors of PTSD in patients with early gastric cancer after ESD, and to provide scientific evidence for clinical psychological intervention.
METHODS
A retrospective analysis was conducted on clinical data of 216 patients with early gastric cancer who underwent ESD treatment at the First Affiliated Hospital of Chongqing Medical University (a tertiary medical center performing approximately 800-1000 ESD procedures annually) from March 2023 to March 2024. All patients had complete data with no missing values. Preoperative psychological assessments (Self-Rating Anxiety Scale, Self-Rating Depression Scale, Social Support Rating Scale) were extracted from routine nursing assessments conducted by trained staff within 24-48 hours of admission. Univariate analysis and multivariate logistic regression analysis were used to identify independent risk factors for PTSD occurrence. A prediction model was constructed, and its predictive performance was evaluated using the receiver operating characteristic curve.
RESULTS
Among 216 patients, 56 developed PTSD, with an incidence rate of 25.9%. Multivariate logistic regression analysis showed that age [odds ratio (OR) = 1.060, 95% confidence interval (CI): 1.013-1.109, P = 0.012], unmarried/divorced/widowed status (OR = 3.077, 95%CI: 1.259-7.516, P = 0.014), lesion size (OR = 1.624, 95%CI: 1.129-2.336, P = 0.009), concurrent ulcer (OR = 2.440, 95%CI: 1.154-5.161, P = 0.020), and preoperative Self-Rating Depression Scale score (OR = 1.064, 95%CI: 1.021-1.109, P = 0.003) were independent risk factors for PTSD occurrence, while preoperative Social Support Rating Scale score (OR = 0.907, 95%CI: 0.848-0.970, P = 0.004) was a protective factor. The prediction model constructed based on these six factors had an area under the curve of 0.856 (95%CI: 0.801-0.910), with a sensitivity of 78.6% and specificity of 85.0%. The Hosmer-Lemeshow test (χ2 = 8.742, P = 0.364) and calibration plot (mean absolute error 0.032) demonstrated good calibration. Bootstrap validation yielded an optimism-corrected C-index of 0.841 (95%CI: 0.783-0.899) with optimism of 1.5%, indicating low overfitting risk.
CONCLUSION
The prediction model based on multiple factors has good predictive performance and may facilitate identification of high-risk patients preoperatively, providing preliminary evidence for early psychological screening. However, prospective multicenter validation is required before clinical implementation.
Core Tip: We quantified post-traumatic stress disorder 3 months after endoscopic submucosal dissection for early gastric cancer and identified six independent preoperative factors - age, marital status, lesion size, ulcer, depression level, and social support. A pragmatic 6-factor model showed good discrimination (area under the curve = 0.856) and allows risk stratification before treatment. This approach supports routine preoperative screening and targeted psychological intervention to improve adherence and recovery.
